<include file="Public/frame-header" />
</head>
<body class="J_scroll_fixed">
	<div class="wrap jj">
		<ul class="nav nav-tabs">
			<li ><a href="{:U('Order/index')}">订单列表</a></li>
			<li class="active"><a href="{:U('/Admin/Order/refund/id/'.$order_id)}">退款</a></li>
		</ul>
		<div class="common-form">
			<form method="post" class="form-horizontal J_ajaxForm" action="{:U('/Admin/Order/refund')}">
				<fieldset>
					<div class="control-group">
						<label class="control-label">户主:</label>
						<div class="controls">
							<input type="text" class="input" name="cardHolder" value="" placeholder="户主">
						</div>
					</div>
					<div class="control-group">
						<label class="control-label">退款帐号:</label>
						<div class="controls">
							<input type="text" class="input" name="card" value="" placeholder="银行卡号">
						</div>
					</div>
					<div class="control-group">
						<label class="control-label">开户行:</label>
						<div class="controls">
							<input type="text" class="input" name="bank_full_name" value="" placeholder="开户行">
						</div>
					</div>
					<div class="control-group">
						<label class="control-label">备注:</label>
						<div class="controls">
							<textarea name="remark" rows="5" cols="57" placeholder="备注"></textarea>
						</div>
					</div>
				</fieldset>
				<div class="form-actions">
					<input type="hidden" name="id" value="{$order_id}" />
					<button type="submit" class="btn btn-primary btn_submit J_ajax_submit_btn">提交</button>
					<a class="btn" href="__URL__">返回</a>
				</div>
			</form>
		</div>
	</div>
	<script src="__ADMIN__/statics/js/common.js"></script>
</body>
</html>